Amenorrhea is a complicated and common problem encountered by primary care physicians. Performing a thorough history and physical examination can often narrow the differential diagnosis considerably. The addition of basic determinations of serum FSH and LH or other tests as indicated by abnormalities on the history or examination can then make the diagnosis more clear. In all cases of primary amenorrhea, treatment is directed by the diagnosis. The primary goal of treatment is to facilitate the normal sexual development through gentle coaxing into puberty. In secondary amenorrhea, there is a greater focus on fertility and prevention of complications from the associated abnormal hormone levels. Probability of conception is dictated by the reversibility of the cause of the amenorrhea.
Active and inactive renin in plasma and peritoneal dialysate were studied in pentobarbitone anesthetized cats during 8 hours of peritoneal dialysis. In control cats, despite a significant rise in plasma active renin from 1.3 +/- 0.22 to 4.4 +/- 0.76 pmoles AI/ml/hr over 8 hours, plasma inactive renin was unchanged. Four-fold rises in plasma active renin after hemorrhage (15 ml/kg) and captopril (1 mg/Kg I.V.) were unaccompanied by significant change in inactive renin. Bilateral nephrectomy resulted in undetectable plasma active renin after 3 hours but plasma inactive renin was 25-30% of initial levels 6 hours post-nephrectomy. In peritoneal dialysate, active renin remained low in control cats but there was a ten-fold rise of inactive renin from 0.06 +/- 0.02 to 0.60 +/- 0.07 pmoles AI/ml/hr. After hemorrhage there was a slight rise of active renin after 3 and 4 hours. Inactive renin was lower than control 6 hours after nephrectomy and captopril, but higher than control 1 and 2 hours after hemorrhage. Dialysate inactive renin accumulation slopes were not different among treatments. Acute changes in plasma active renin have little effect on peritoneal dialysate renin.
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